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Understanding Transient Blood Pressure Elevation Causes During Pregnancy

Explore the possible causes of transient blood pressure elevation in pregnancy, including drug use, obesity, white coat hypertension, and hypertensive disorders like preeclampsia. Learn about the criteria and diagnosis for chronic and gestational hypertension, as well as conditions like HELLP syndrome.

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Understanding Transient Blood Pressure Elevation Causes During Pregnancy

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  1. Possible Causes of Transient blood pressure elevation • Drug use (cocaine, meth, tobacco) • Obesity (wrong cuff size) • White coat HTN, anxiety • Pain • Hypertensive Disorders of Pregnancy

  2. Categories of Hypertension During Pregnancy • Preeclampsia-eclampsia • Chronic hypertension • Chronic hypertension with superimposed preeclampsia • Gestational hypertension

  3. Chronic Hypertension • Diagnosis: elevated blood pressure > 140/90 prior to 20 weeks gestation x2 at least 4 hours apart

  4. Gestational Hypertension • Diagnosis: HTN (BP > 140/90) after 20 wks pregnancy without proteinuria or other criteria for preeclampsia

  5. Preeclampsia without severe features • Diagnosis: 1. BP > 140/90 x2 at least 4 hours apart 2. proteinuria: >300 mg on 24 hour urine or P/C ratio fo 0.3 or greater • Urinary protein levels do not correlate with severity

  6. Preeclampsia with severe features • BP > 160/110 at least four hours apart unless meds are started before that time • Thrombocytopenia < 100,000 • LFT’s 2x normal or RUQ/epigastric pain • Renal insufficiency: Cr 1.1 or doubling of baseline • Pulmonary edema • New-onset cerebral/visual disturbances ***ANY ONE OF THE ABOVE CRITERIA in combination with hypertension is sufficient for the diagnosis*** Proteinuria is not necessary if any are present

  7. HELLP Syndrome • AST or ALT > 2x normal • LDH > 600 • Bili > 1.2 mg/dL • Platelets < 100,000 • DIC panel (fibrinogen, PT, PTT) should be ordered if plts <50,000 or signs/sx of bleeding • Atypical HELLP may not meet BP criteria for preeclampsia diagnosis

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